data collection

Nothing much really dramatic happened last night. Brad has quizzed me enough when I call him with questions that I’m starting to get the hang of doing a thorough but very fast evaluation before calling him. It’s kind of tricky to know how sick the patient is, and how much time I have to gather how much information before calling. Usually, I think, seeing as I’m on the regular floors, there’s enough time to get all the information: vital signs, pulse ox, urine output, NG output, type of iv fluids and rate they’re running at, and how much pain medicine the patient has received lately (if they’re now delirious) – seem to be the usually pertinent facts. The problem is that the nurses rarely know more than a few of these points, so I have to harass them slightly to find out. There’s 100cc in the foley bag now? Great; when was the last time it was emptied; you don’t know? Who would know? Because the answer makes a difference; two hours ago is fine; eight hours ago, before shift change, is not so great. I know the blood pressure measured at 8pm was 130/70, and that’s what’s recorded on the sheet. But right now, at 11pm, the patient is tachypneic and tachycardic; I know we only have one aide for the whole floor, but can we find her, or the blood pressure cuff, and recheck, now? Other times, the nurses do have all the information, but it’s written down on their note sheets, not on the vitals sheet in the room, or in the computer. Which is kind of bewildering to me; because to my mind, the point of vitals and ins-and-outs, being requested by the physician, is to be available for the physician’s information. So if you take detailed notes for an eight hour shift, but it’s all on a paper somewhere in the stack on the table in the nurses’ cubbyhole, that doesn’t help much when I come in a hurry to evaluate a patient. Oh well. It’s just a few more minutes of talking.

And then there was the nurse who called around 5am to inform me that an octagenarian with a million medical problems hadn’t had any urine output – in the foley! – all night. For once I agreed with Brad’s furious assessment, and was willing to be angry with the nurse; but I couldn’t find the words.

Brad keeps saying I’m doing a good job, and I can never quite tell whether he’s being serious, or superlative. Last night, though, I did run into a rather glaring instance of another intern doing a great many bad things, on a scale a little beyond my imagination. So I guess compared to that degree of mismanagement, I’m doing ok. But immediately after that incident, some other things happened to remind me that, if I’m not that wildly irresponsible, it’s only by God’s grace. There are dozens of times every night when I could do something quite bad, and just remember in the nick of time. There’s no space to relax.

(Why is it that now that I’m home, with a night off, the trauma pager is suddenly going off with all kinds of wild and dramatic events? Why does that never happen while I’m at the hospital? I ought to start tracking statistics, to see if there’s a decline in the city’s traumatic mortality rate in a few years, when I’m in charge of the trauma service. . . )

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2 Responses to “data collection”

How does night float work hour-wise? Do services sign out to you at a specific time, and then take over again in the morning? Do you have to round/write notes etc? Would you recommend night float over standard q4 call?

The hours are 6pm-6am, plus conference a couple mornings a week, for a total of 78 hours a week (if you come and go exactly on time). Not bad. I show up a few minutes before six so the interns on the five general surgery services can sign out their lists to me. Some of them are pretty detailed, which I appreciate; others will just point out the most recent post-ops and leave it at that. Those are usually the lists from which trouble will come overnight. Then when they come back between 4 and 5am, they check with me and find out what new admissions and major problems happened overnight. I’m still around till 6, so if anything major happens, I take care of it and they can finish rounding.

I don’t have technical rounds, although I’m discovering that if I go around and check on the sickest people, I find things out sooner than by waiting for the nurses to call (like that “no urine for 6 hours” story). I do have to write “called-to-see-patient” notes if I get called for things like tachycardia, decreased urine output, AMS, or – not so far – bleeding. Which is fine, because it’s pretty easy to write a note on such a specific event.

I highly recommend the night float system. For the people who aren’t on it for the month, it’s tremendous. You get to go home at a reasonable hour every night, you get to finish rounds without disturbance, and you only have call on weekends. Much, much less stressful than the traditional q4 (or q3) call. For two months a year, it’s kind of painful at first, but by now I know most of the names, I know who the sick people are, and I don’t have to ask for a complete history from the nurses when they call. For the seniors, who cover the ICU, it’s even more difficult; but still worth it for the sake of not having regular call. If you find a program with night float that’s at least decent in other regards, that fact ought to count for a great deal in your ranking.